S-4.2, r. 22 - Regulation respecting the procedure for designating certain members of the board of directors of the public institution referred to in Part IV.2 of the Act respecting health services and social services

Schedule Disposition versions

2012-09-01

SCHEDULE VII

(s. 25)

DESIGNATION

NORD-DU-QUÉBEC INSTITUTION

Compilation of vote counts and draw results

Institution(s): ________________________________________________________________________

Designation college: __________________________________________________________________

Polling date: ________________________________________________________________________

Polling period: _______________________________________________________________________

(1) Vote Count Report

Envelopes with voter identified: __________

Envelopes containing no vote envelopes: __________

Envelopes containing more than one vote envelope: __________

Vote envelopes counted: __________

Uncounted vote envelopes: __________

Candidates Number of votes

(1) ___________________ __________

(2) ___________________ __________

(3) ___________________ __________

Valid ballots __________

Rejected ballots __________

Total __________

(2) Draw results

The following candidates received the same number of votes:

_____________________________

_____________________________

_____________________________

_____________________________

A random draw was held on ____________________, in ____________________

The following candidate’s name was drawn:

_____________________________

Signed in _____________________, on _____________________

_____________________________

Signature

_____________________________

Name of designation officer

M.O. 2006-013, Sch. VII.